title: Severity of emphysema predicts location of lung cancer and 5-y survival of patients with stage I non-small cell lung cancer.
abstract: BACKGROUND
  Non-small cell lung cancer (NSCLC) has a predilection to occur in emphysematous lungs. The relation between the regional severity of emphysema and the location of NSCLC as well as long-term survival has been poorly studied.
  
  
  METHODS
  Computed tomography (CT) scans of 153 patients with biopsy-proven stage I NSCLC diagnosed between 2001 and 2006 were assigned an emphysema severity score in four regions of the lung. The location of the cancer was compared with the severity of emphysema in that region. Survival was also analyzed.
  
  
  RESULTS
  Thirty-nine patients had no emphysema documented on CT scan and 114 did. The most common location of cancer was the right upper quadrant with 37% of cancers, followed by the left upper quadrant with 23% of cancers. Twenty-two percent of the cancers occurred in the right lower quadrant, and only 12% were in the left lower quadrant. There is a strong association for cancer being located in the area with the highest degree of emphysema (P < 0.001). Emphysema severity score was also associated with long-term survival (log-rank P = 0.03).
  
  
  CONCLUSIONS
  The regional severity of emphysema assessed via a visual scale using CT appears to be associated with the location of lung cancer and is an independent predictor of long-term survival.
authors.affiliation: Cardiothoracic Surgery, SUNY at Stony Brook, Stony Brook, New York, USA.
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.forename: William
authors.initials: W
authors.lastname: Moore
authors.forename: Thomas
authors.initials: T
authors.lastname: Bilfinger
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D004646:Emphysema / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013147:Spirometry; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: Diagnosis; Emphysema; Lung cancer; Screening